Nurses: Climb the Leadership Ladder, Call the ‘Circle’

Linda Burnes Bolton, DrPH, RN, FAAN, is vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles, Calif., and a member of the Robert Wood Johnson Foundation (RWJF) Board of Trustees.

When troubles arose in ancient times, tribal leaders, known as “circle callers,” called on villagers to discuss problems and explore solutions as they sat together around a communal fire.

We need more of this kind of inclusive decision-making in our modern hierarchical society, and in our health care system in particular—and nurses are in a prime position to make that happen.

Nurses, I believe, are natural circle callers. They assess health from all sides and all angles. They look at individuals’ symptoms and diagnoses, but also their diet and exercise habits, their living and working conditions, their neighborhood environments and personal resources. They spend more time with patients than other health care providers and develop strong, trusting relationships with them and their loved ones. They focus on patients, but they also work with family members, caregivers, providers, administrators, payers, and community-based supporters.

In our health care system, nurses are masters of inclusive decision-making. We need nurses in positions of power so they can share their unique insights and help answer pressing and persistent questions like how to narrow deeply troubling disparities in health and health care; how to provide more coordinated and more patient-centered care; and how to improve the quality and safety of care while, at the same time, reducing costs.

We need nurses at the leadership table but, sadly, they are often not there. Nurses comprise the largest segment of our nation’s health care workforce but they are vastly underrepresented in C-Suite executive offices and on executive boards at hospitals and health care facilities. We rarely hear from nurses in national debates about health care reform.

That needs to change. I know because I’ve seen what can happen when nurses have a seat at that proverbial decision-making table.

A few decades ago, I was appointed to serve on the steering committee of the California Area Health Education Center. I was the only nurse on the committee who wasn’t also a staff member, and I was concerned when I discovered the vast funding imbalance between nurse and medical education at the University of California (UC) system. My colleagues and I decided to push for more federal funding for nursing education at UC schools, and we got it. I also led calls for more diversity in health professional schools and created a team to advocate on behalf of minority health professionals.

I have taken a similar approach in the many other leadership positions I have held since then. I helped create the Congressional Black Caucus Health Braintrust, an authority on minority health policy on Capitol Hill; the Black Congress on Health, Law, and Economics; and the Office of Minority Health, an office at the U.S. Department of Health and Human Services that aims to improve the health of racial and ethnic minority populations.

I have held leadership positions in numerous national nursing organizations, and I was the first Black woman, and the first nurse, to serve on the Case Western Reserve University Board of Trustees. Two years ago, I was elected to serve on the board of trustees at RWJF, the nation’s largest philanthropy devoted exclusively to health and health care.

Often, I am the only nurse leader, or one of very few, in a room. We need more nurse leaders, and it’s not just about numbers or titles. It’s about having leaders who not only care about human beings but who also understand all that goes into caring for them.

Throughout my career, as a nurse, as an educator, as an administrator, and as a leader, I have tried to “call the circle”—I have talked and listened to as many people as possible, from as many backgrounds as possible, to understand what people need and want to improve their lives. We need more leaders, more “circle callers,” in health care, so we can take all viewpoints into account and better enable all people live healthy, happy, and productive lives. And I believe nurses have the skills to be those kinds of leaders.

So, my fellow nurses, my message to you is: Climb that ladder, and call the circle.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

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